全髋置换和多节段截骨治疗强直性脊柱炎驼背并髋骨性屈曲强直

Total Hip Replacement and Multisegment Transpedicular Wedge-osteotomy for Kyphosis in Ankylosing Spondylitis Involving Hip Bony Ankylosis

【目的】评价多节段脊柱环绕截骨矫正术和髋关节置换术,探讨两种手术各自的指征和优点。【方法】328例强直性脊柱炎驼背矫正和48例强直性脊柱炎髋关节屈曲强直行手术的患者中,同时有驼背伴随髋关节骨性屈曲强直9例,先行髋关节置换,然后强直性脊柱炎驼背行经椎弓根一次性多节段脊柱环绕截骨矫正术,生物力学原理设计截骨术。随访5年以上,行髋关节置换效果按Harris标准结合X线片评价,并对脊柱受力进行生物力学分析。【结果】优5例,良2例,一般1例,差1例。所有病人髋关节活动范围明显增大。多节段椎弓椎体截骨驼背矫正术后,矫正Cobb′s角56°(40°￣88°),驼背矫正率78%。较好地恢复脊柱的生理曲线和负重特点。术后无神经血管损伤,感染和死亡等并发症。【结论】先行全髋关节置换手术,再多节段椎弓椎体截骨矫正驼背,是强直性脊柱炎驼背并髋关节骨性屈曲强直的较佳手术方案。

[Objective] To evaluate the effects of total hip replacement and multisegment transpedicular wedgeosteotomy on the correction of kyphosis and hip flexion deformity secondary to ankylosing spondylitis, and discuss the indication and the priority of two different techniques in the patients with ankylosing spondylitis in involvement of both hip and spine. [Methods] A total of 328 patients undergone one-stage produce circumferential spine osteotomy and multisegment transpedicular wedge-osteotomy for the correction of kyphosis secondary to ankylosing spondylitis, and 48 patients with hip flexion deformity caused by ankylosing spondylitis undergone total hip replacement. Among them, 9 cases suffered from hip bony ankylosis flexion deformity and kyphosis. Biomeehanical technique was applied for the design of multi-level spinal wedge-osteotomy of kyphosis correction. All patients followed up for more than 5 years were reviewed. The Harris method and X-ray films were used to evaluate the clinical results. The operation was analyzed by biomechanics. [Results] Follow-up examination showed excellent function of the joints in 5 cases, good in 2 cases, fair in 1 case, poor in 1 case. All of the patients had substantial improvement of function and the range of motion as well as the posture. The pediele of vertebral arch, vertebral body, and Cobb＇ s angle were measured on X-ray film and were taken important parameters. The average correction was 56 degree （40°～ 88°） with a successful correction rate of 78%. Physiological curves and normal weight-beating line of the spine were partly restored. No complications such as paraplegia, blood vessel injures, infection,and death occurred. [Conclusion] Muhisegment transpedicular wedge-osteotomy followed by total hip replacement is the best option for the treatment of kyphosis and hip bony ankylosis flexion deformity caused by ankylosing spondylitis.